Nothing Special   »   [go: up one dir, main page]
Skip to main content
Springer Nature Link
Log in

Do physical diagnostic tests accurately detect meniscal tears?

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Numerous physical tests have been described but their diagnostic accuracy is often questioned. Karachalios et al. described the new ‘Thessaly test’ and concluded that it could be safely used as a first line screening test for the selection of patients who need arthroscopic meniscal surgery. Our objective was to study the role of physical diagnostic tests in screening for meniscal tears and to validate the diagnostic accuracy of the Thessaly test. We examined 109 patients (80 male, 29 female; average age: 39 years; range: 16–56) who were presented with a history suggestive of a meniscal tear. Joint line tenderness, McMurray’s test, and the Thessaly test were assessed by an independent investigator blinded to any imaging data in all patients. MRI and subsequent arthroscopy results were then collated. Our study showed a much lower diagnostic accuracy for the Thessaly test (61% for medial meniscus and 80% for lateral meniscus). It is comparable to McMurray’s test (57% for medial meniscus and 77% for lateral meniscus). The Joint line tenderness test has a far superior diagnostic accuracy (81% for medial meniscus and 90% for lateral meniscus). However, combining the joint line tenderness test with McMurray’s test or the joint line tenderness test with Thessaly test further increased the accuracy of physical diagnosis of meniscal tears. Magnetic resonance imaging (MRI) detected 96% of meniscal tears. Physical tests may not always be diagnostic of meniscal tears. MRI and arthroscopy may be essential in dubious clinical presentations and especially where more than one pathology is suspected. Our study showed that the Thessaly test in isolation was not useful for the detection of meniscal tears but it helps to increase diagnostic certainty when combined with other standard tests.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Anderson AF, Lipscomb AB (1986) Clinical diagnosis of meniscal tears. Description of a new manipulative test. Am J Sports Med 14:291–293

    Article  PubMed  CAS  Google Scholar 

  2. Apley G (1947) Diagnosis of meniscus injuries. J Bone Joint Surg 29:79–84

    Google Scholar 

  3. Daniel D, Daniels G, Aronson D (1982) The diagnosis of meniscus pathology. Clin Orthopaedics 163:218–224

    Google Scholar 

  4. DeHaven KE, Collins HR (1975) Diagnosis of internal derangements of the knee. The role of arthroscopy. J Bone Joint Surg Am 57:802–810

    PubMed  CAS  Google Scholar 

  5. Eren OT (2003) The accuracy of joint line tenderness by physical examination in the diagnosis of meniscal tears. Arthroscopy 19:850–854

    PubMed  Google Scholar 

  6. Fisher SP, Fox JM, Del Pizzo W et al (1991) Accuracy of diagnoses from magnetic resonance imaging of the knee. A multi-center analysis of 1014 patients. J Bone Joint Surg Am 73:2–10

    Google Scholar 

  7. Hey W (1803) Practical observations in surgery, Chap. 6. London

  8. Johnson RJ, Kettelkamp DB, Clark W, Leaverton P (1974) Factors effecting late results after meniscectomy. J Bone Joint Surg Am 56:719–729

    PubMed  CAS  Google Scholar 

  9. Karachalios T, Hantes M, Zibis AH et al (2005) Diagnostic accuracy of a new clinical test (the Thessaly Test) for early detection of meniscal tears. J Bone Joint Surg Am 87a:955–962

    Article  Google Scholar 

  10. McMurray TP (1942) The semilunar cartilages. Br J Surg 29:407–414

    Article  Google Scholar 

  11. Medler RC, Mandiberg JJ, Lyne DE (1980) Meniscectomies in children. Am J Sports Med 8:87–92

    Article  Google Scholar 

  12. Miller GK (1996) A prospective study comparing the accuracy of the clinical diagnosis of meniscus tears with magnetic resonance imaging and its effect on clinical outcome. Arthroscopy 12:406–413

    Article  PubMed  CAS  Google Scholar 

  13. Muellner T, Weinstabl R, Schabus R et al (1997) The diagnosis of meniscal tears in athletes: a comparison of clinical and magnetic resonance imaging investigations. Am J Sports Med 25:7–12

    Article  PubMed  CAS  Google Scholar 

  14. Noble J, Erat K (1980) In defence of the meniscus. J Bone Joint Surg 62B:7–11

    Google Scholar 

  15. Rose NE, Gold SM (1996) A comparison of accuracy between clinical examination and magnetic resonance imaging in the diagnosis of meniscal and anterior cruciate ligament tears. Arthroscopy 12:398–405

    PubMed  CAS  Google Scholar 

  16. Scholten RJ, Deville WL, Opstelten W et al (2001) The accuracy of physical diagnostic tests for assessing meniscal lesions of the knee: a meta-analysis. J Fam Pract 50:938–944

    PubMed  CAS  Google Scholar 

  17. Selesnick FH, Noble HB, Bachman DC et al (1985) Internal derangement of the knee: diagnosis by arthrography, arthroscopy, and arthrotomy. Clin Orthop 198:26–30

    PubMed  Google Scholar 

  18. Shakespeare DT, Rigby HS (1983) The bucket-handle tears of the meniscus. A clinical and arthrographic study. J Bone Joint Surg Br 65:383–387

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University College Hospital, 25 Grafton Way, London, WC1E 6AA, UK

    Sujith Konan, Faizal Rayan & Fares Sami Haddad

Authors
  1. Sujith Konan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Faizal Rayan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fares Sami Haddad
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sujith Konan.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Konan, S., Rayan, F. & Haddad, F.S. Do physical diagnostic tests accurately detect meniscal tears?. Knee Surg Sports Traumatol Arthrosc 17, 806–811 (2009). https://doi.org/10.1007/s00167-009-0803-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-009-0803-3

Keywords

Search

Navigation